Ultrasound Guided Liver Resection: Does This Approach Limit the Need for Portal Vein Embolization?
Guido Torzilli*1,2, Matteo Donadon1,2, Angela Palmisano1,2, Matteo Marconi1,2, Fabio Procopio1,2, Florin Botea1,2, Daniele Del Fabbro1,2, Marco Montorsi2
1Liver Surgery Unit, 3rd Department of Surgery, University of Milan, Istituto Clinico Humanitas - IRCCS, Rozzano - Milano, Italy; 23rd Department of Surgery, University of Milan, Istituto Clinico Humanitas - IRCCS, Rozzano - Milano, Italy
Background: Since major removal of liver parenchyma is undoubtedly associated with higher risk of morbidity and mortality, portal vein embolization (PVE) has been advocated to minimize that risk. However, PVE itself has associated morbidity. Ultrasound-guided resection minimizing the need for major resections, could make PVE mostly unnecessary. The aim of this study was to validate this hypothesis.Material and
Methods: Two hundred and fifty-three consecutive patients who underwent liver surgery were reviewed. Sixty-eight of these patients with tumors corresponding to right 1st/2nd order portal branches (Zone P) and right hepatic vein (Zone H) were selected as potential candidates for major hepatectomy and as consequence to PVE. Indications to PVE were defined according to the most recent reported criteria based on liver background, and expected remnant liver volume. Surgical strategy was based on the relationship between the tumor and the intrahepatic vascular structures at intraoperative ultrasonography (IOUS). Postoperative outcome, rate of local recurrence, rate of major hepatectomy and PVE were analyzed.
Results: Thirty-seven (54%) patients with tumors located in Zones H and P were potential candidates to PVE, but none underwent this procedure. Major hepatecomies were performed in 5 (7%) patients. No hospital mortality was seen. Morbidity rate was 15% and major morbidity occurred in 2 patients. Blood transfusion rate was 11%. Mean tumor-free margin was 0.13 cm (median 0.1; range 0-0.6). None had local recurrence after a mean follow-up of 27.3 months (median 25; range 6-61).
Conclusions: In conclusion, these results show that IOUS guidance allows an alternative, safe, and effective surgical approach for patients generally submitted to major hepatectomy and most of them to preoperative PVE. In this perspective, further studies are required to reassess indications to PVE.
